The Affordable Care Act is not quite ready, some of the key aspects won't be available and many large corporations are still exempt, but it is rolling out for individuals tomorrow. 76% of U.S. adults are aware of the law's individual mandate - they know the law will require them to have insurance or pay penalties - but only 40% are aware that new health insurance marketplaces are (in many cases) opening on October 1, or that financial assistance that is available to help people with low or moderate incomes pay their health insurance premiums.

The latest survey by the Commonwealth Fund, an advocacy group to promote government health insurance, also finds broad support for expanding Medicaid in all states, with 68 percent of adults saying they are somewhat or strongly in favor of making Medicaid available to more residents in their state. But it highlights a problem; the people most likely to benefit from health insurance marketplaces and premium subsidies yet least likely to be aware of them. 

According to the report based on the survey, What Americans Think of the New Insurance Marketplaces and Medicaid Expansion:

•  Only 32 percent of people without health coverage at some point during the past year (which includes students, temporary unemployment and people who quit) are aware of the marketplaces, compared to 43 percent of people with coverage all year. 

•  31 percent of people without coverage at some point during the year  (which includes students, temporary unemployment and people who quit)  are aware of the subsidies that are available, compared to 43 percent of those insured all year.  

•  32% of adults with incomes under the federal poverty level ($11,490 for an individual and $23,550 for a family of four) are aware of the subsidies, compared to 47 percent of those with higher incomes.  

The survey finds that once people are made aware of the marketplaces, 61 percent of those who are potentially eligible—because they were either uninsured at the time of the survey or had purchased an individual insurance plan—said they are very or somewhat likely to shop for coverage in the marketplaces. A slight majority of young adults (55%) ages 19 to 29 who are potentially eligible for the coverage options said they are very or somewhat likely to use the marketplaces - that makes sense, since by law adults up to age 26 can now tag along on their parents' plans - compared to 65 percent of those ages 30 to 49, when they have to have insurance or be penalized.

Potentially eligible adults with health problems were slightly more likely to say they would use the marketplaces than adults with no health problems (65% vs. 57%). Nearly equal shares of potentially eligible people who identify themselves as Democrats or Republicans said they are very or somewhat likely to shop in the marketplaces (67% vs. 63%).  

"These survey findings demonstrate that people who need the health insurance coverage the marketplaces will offer want to shop for plans and find out if they are eligible for financial help," said Commonwealth Fund vice president Sara Collins, Ph.D., the study's lead author. "However, more work needs to be done to ensure that people who may be eligible are aware of the marketplaces and the subsidies. State and federal efforts to educate people about the marketplaces during the six-month enrollment period beginning in October need to be intensive enough to help close the information gaps this survey highlights."

Support for Medicaid Expansion

Despite the fact that only 25 states and the District of Columbia have agreed to expand Medicaid under the Affordable Care Act, strong majorities of Americans support doing so. Across the country, 68 percent of adults are somewhat or strongly in favor of making Medicaid available to more residents in their state. The report also finds that:

• 78% of people without insurance for a time during the past year, and 82% of people earning less than $32,499 a year for a family of four, support expanding Medicaid to more people in their state.

• 91% of uninsured Democrats, 78% of uninsured Independents and 73% of uninsured Republicans strongly or somewhat favor their state making Medicaid available to more residents.

• 91% of Democrats, 79% of Independents and 75% of Republicans making less than $32,499 a year for a family of four are in favor of making Medicaid available to more people.
• 85% of adults surveyed do not know what their state has decided regarding the Medicaid expansion, among those who do, 68% of those who are aware their state is expanding Medicaid are in favor of that decision.
• 38% of adults who know their state is not expanding Medicaid are strongly or somewhat in favor of their state's decision.

"The strong support for expanding Medicaid is consistent with past studies showing that Americans generally like the individual components of the Affordable Care Act when they understand them," said Commonwealth Fund president David Blumenthal, M.D. "This study also shows that there is a great deal of work to be done to ensure that Americans have a clear, accurate view of the law and what it offers the American people."

Link: S. R. Collins, P. W. Rasmussen, M. M. Doty, Ph.D., and T. Garber, What Americans Think of the New Insurance Marketplaces and Medicaid Expansion, The Commonwealth Fund, September 2013.